HEMOPTYSIS
Allen Widysanto
DEFINITION
Hemoptysis is defined as the spitting of
blood derived from the lungs or bronchial
tubes as a result of pulmonary or
bronchial hemorrhage
CLASSIFICATION
HEMOPTYSIS
MASSIVE NONMASSIVE
Blood loss 200-1000 ml/24 hours Blood loss less than 200 ml
NO DEFINITE CRITERIA
Massive hemoptysis
Pulmonology and Respiratory Department
at FKUI /Persahabatan Hospital has own
criteria.
Blood loss 600 ml/24 hours and it doesnt stop on observation
Blood loss 250 ml but 600 ml/24 hours, Hb level 10 g%, hemoptysis
still occured
Blood loss > 250 ml but 600 ml/24 hours, hb level > 10 g%,
observation during 48 hours + conservative treatment , hemoptysis
still occured
Causes
idiopathic
PULMONARY EXTRA PULMONARY
Upper Respir Tract
Tuberculosis
Bronchitis GIT
Ex Tuberculosis Bronchiectasis
Fungal infection
Dental/gum
Lung cancer
PH-MS
THE MOST IMPORTANT IS THE SOURCE
OF HEMOPTYSIS Coagulopathy
PATHOPHYSIOLOGY
Aneurysme Rasmussen
TUBERCULOSIS Lymphadenopathy
Bronchiectasis
Non specific Superficial mucosa inflammation may lead
Rupture of Superficial blood vessel
infection
bacterial virus fungi
Superficial mucosal invasion
LUNG CANCER
Erosion into blood vessel
Angiogenesis
Secondary infection
CARDIAC Left ventricular HF
Mitral Stenosis
IT IS DEPEND ON THE CAUSES
Hemoptysis in children
LOWER RESPIRATORY TRACT INFECTION
FOREIGN BODY ASPIRATION
BRONCHIECTASIS
PULMONARY TB .. Very rare
Hemoptysis vs Hematemesis
Absence of nausea and vomiting Presence of nausea and vomiting
Lung disease Gastric or hepatic disease
Asphyxia possible Asphyxia unusual
Sputum examination
Frothy Rarely frothy
Liquid or clotted appearance Coffee ground appearance
Bright red or pink Brown to black
Laboratory
Alkaline pH Acidic pH
Mixed with macrophages and neutrophils Mixed with food particles
DIAGNOSTIC
history taking
CLINICAL CLUES SUGGESTED DIAGNOSIS
Anticoaulant use Medication effect, coagulation disorder
Association with menses Catamenial hemoptysis
Dyspnea on exertion, fatigue, orthopnea, paroxysmal Mitral valve stenosis
nocturnal dyspnea, frothy sputum
Fever, productive cough Upper Respiratory infection, acute sinusitis, bronchitis,
pneumonia, lung abscess
History of breast,colon or renal cancer Metastatic disease of lungs
History of chronic lung disease, recurrent LRTI, cough with
copius sputum
Bronchiectasis
???
HV, immunosuppresion Neoplasia, tuberculosis, Kaposis sarcoma
Nausea, vomiting, melena, alcoholism, chronic use of NSAID Gastritis, gastric or peptic ulcer, esophageal varices
Pleuritic chest pain, calf tenderness Pulmonary embolism or infarction
Tobacco use Acute bronchitis, chronic bronchitis, lung cancer,
pneumonia
Travel history Tuberculosis, parasites, biologic agents
Weight loss Emphysema, lung cancer, tuberculosis,bronchiectasis,
lung abscess, HIV
DIAGNOSTIC
Physical Examination
Cachexia, clubbing, hoarseness, hyperpigmentation, Lung cancer
Horners syndrome
Clubbing Primary lung cancer, bronchiectasis, severe lung
metastasis
Dullness to percussion, fever, unilateral rales Pneumonia
Facial tenderness, fever, mucopurulent nasal discharge, Acute URTI, acute sinusitis
postnasal drainage ????
Fever, tachypnea, hypoxia, barrel chest, ICS retraction, pursed lip AECB
breathing
Heart murmur, pectus excavatum Mitral valve stenosis
Tahypnea, tachycardia, dyspnea, unilateral leg pain, Pulmonary thromboembolic disease
edema
DIAGNOSTIC EVALUATION
Historytaking
Physical examination
Supportive:
chest X ray
Sputum evaluation
Blood gas analysis
CT scan
Bronchoscopy
Harrison 15th,ed.
MANAGEMENT OF MASSIVE
HAEMOPTYSIS
Airway protection and resuscitation
Identifying the site and cause of
bleeding
Bronchoscopic treatment
Bronchial artery embolization (BAE)
Surgical treatment
SURGICAL MANAGEMENT
